Abstract
Purpose
The purpose of this study was to investigate associations between the various definitions of adding-on identified in the literature and HRQoL at 10 years following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) to identify a clinically relevant definition.
Methods
In this retrospective cohort study, patients with Lenke type 1 or 2 AIS with 10-year follow-up after PSF were identified in a multicenter registry. Adding-on was identified independently using 5 published definitions and expert spine surgeons’ visual confirmation. Worsening of HRQoL was defined as a preoperative to 10-year postoperative decrease in SRS-22 domain score ≥ the minimal clinically important difference (MCID).
Results
One hundred fifty patients were included, and 118 had HRQoL data available for the main analysis. Worsening pain was noted in 49 (41.5%) patients, appearance in 1 (0.8%), and activity in 70 (59.3%) from preoperative to postoperative. 4 of the 5 definitions of adding-on demonstrated no evidence of association with worsening HRQoL. By Cho’s definition (either 1. ≥ 5° increase in Cobb angle AND increase in number of vertebrae in curve distally, or 2. ≥ 5° increase in angulation of 1st disc below LIV), adding-on (27 patients, 22.9%) was associated with an increased risk of worsening pain (59.3% vs. 36.3%, p = 0.033) and activity (77.8% vs. 53.8%, p = 0.026). There was no evidence of association with changes in appearance. Risk of worsening pain and activity was increased by 1.75 and 1.51 times (p = 0.023 and p = 0.002), respectively.
Conclusion
Cho’s definition of adding-on was associated with worsening HRQoL at 10 years following PSF for Lenke type 1 and 2 AIS. Consistent use of this definition will allow us to compare studies and obtain meaningful information in this population.
Level of evidence
Level II.
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Acknowledgements
Harms Study Group Investigators: Aaron Buckland, MD; New York University; Amer Samdani, MD; Shriners Hospitals for Children—Philadelphia; Amit Jain, MD; Johns Hopkins Hospital; Baron Lonner, MD; Mount Sinai Hospital; Benjamin Roye, MD; Columbia University; Burt Yaszay, MD; Rady Children’s Hospital; Chris Reilly, MD; BC Children’s Hospital; Daniel Hedequist, MD; Boston Children’s Hospital; Daniel Sucato, MD; Texas Scottish Rite Hospital; David Clements, MD; Cooper Bone & Joint Institute New Jersey; Firoz Miyanji, MD; BC Children’s Hospital; Harry Shufflebarger, MD; Paley Orthopedic & Spine Institute; Jack Flynn, MD; Children’s Hospital of Philadelphia; John Asghar, MD; Paley Orthopedic & Spine Institute; Jean Marc Mac Thiong, MD; CHU Sainte-Justine; Joshua Pahys, MD; Shriners Hospitals for Children—Philadelphia; Juergen Harms, MD; Klinikum Karlsbad-Langensteinbach, Karlsbad; Keith Bachmann, MD; University of Virginia; Lawrence Lenke, MD; Columbia University; Lori Karol, MD; Children’s Hospital, Denver Colorado; Mark Abel, MD; University of Virginia; Mark Erickson, MD; Children’s Hospital, Denver Colorado; Michael Glotzbecker, MD; Rainbow Children’s Hospital, Cleveland; Michael Kelly, MD; Washington University; Michael Vitale, MD; Columbia University; Michelle Marks, PT, MA; Setting Scoliosis Straight Foundation; Munish Gupta, MD; Washington University; Nicholas Fletcher, MD; Emory University; Noelle Larson, MD; Mayo Clinic Rochester Minnesota; Patrick Cahill, MD; Children’s Hospital of Philadelphia; Paul Sponseller, MD; Johns Hopkins Hospital; Peter Gabos, MD: Nemours/Alfred I. duPont Hospital for Children; Peter Newton, MD; Rady Children’s Hospital; Peter Sturm, MD; Cincinnati Children’s Hospital; Randal Betz, MD; Institute for Spine & Scoliosis; Stefan Parent, MD: CHU Sainte-Justine; Stephen George, MD; Nicklaus Children's Hospital; Steven Hwang, MD; Shriners Hospitals for Children—Philadelphia; Suken Shah, MD; Nemours/Alfred I. duPont Hospital for Children; Sumeet Garg, MD; Children’s Hospital, Denver Colorado; Tom Errico, MD; Nicklaus Children's Hospital; Vidyadhar Upasani, MD; Rady Children’s Hospital.
Harms Non-Fusion Study Group Investigators: Amer Samdani, MD; Shriners Hospitals for Children—Philadelphia; Ahmet Alanay, MD; Acibadem Maslak Hospital, Turkey; Baron Lonner, MD; Mount Sinai Hospital; Bob Cho, MD; Shriner’s Pasadena CA; Burt Yaszay, MD; Rady Children’s Hospital; Caglar Yilgor, MD; Acibadem Maslak Hospital, Turkey; Dan Hoernschmeyer, MD; University of Missouri Health Care; Firoz Miyanji, MD; BC Children’s Hospital; Harry Shufflebarger, MD; Paley Orthopedic & Spine Institute; John Asghar, MD; Paley Orthopedic & Spine Institute; Josh Murphy, MD; Children's Healthcare of Atlanta; Kevin Neal, MD; Nemours Children’s Clinic, Jacksonville; Laurel Blakemore, MD; Pediatric Specialists of Virginia/Children’s National; Lawrence Haber, MD; Ochsner health center for children New Orleans; Noelle Larson, MD; Mayo Clinic Rochester Minnesota; Patrick Cahill, MD; Children’s Hospital of Philadelphia; Peter Newton, MD; Rady Children’s Hospital; Stefan Parent, MD: CHU Sainte-Justine; Suken Shah, MD; Nemours/Alfred I. duPont Hospital for Children.
Funding
This study was supported in part by grants to the Setting Scoliosis Straight Foundation in support of Harms Study Group research from DePuy Synthes Spine, EOS imaging, Stryker Spine, Medtronic, NuVasive, Zimmer Biomet and the Food and Drug Administration.
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BDR, HM, ANF, GFM, RRI, AB, NB, LGL, PON and MGV made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work. BDR, HM, ANF, GFM, RRI, AB, NB, LGL, PON and MGV drafted the work or revised it critically for important intellectual content. BDR, HM, ANF, GFM, RRI, AB, NB, LGL, PON and MGV approved the version to be published. BDR, HM, ANF, GFM, RRI, AB, NB, LGL, PON and MGV agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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This study was approved by the Columbia University Institutional Review Board (Protocol AAAR3052) and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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Informed consent was obtained from each subject upon enrollment in the adolescent idiopathic scoliosis (AIS) registry.
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Roye, B.D., Matsumoto, H., Fano, A.N. et al. Distal adding-on in adolescent idiopathic scoliosis results in diminished health-related quality of life at 10 years following posterior spinal fusion. Spine Deform 10, 515–526 (2022). https://doi.org/10.1007/s43390-021-00432-1
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DOI: https://doi.org/10.1007/s43390-021-00432-1